Whole-genome sequencing for predicting clarithromycin resistance in Mycobacterium abscessus

Journal article

Mycobacterium abscessus is emerging as an important pathogen in chronic lung diseases, with concern regarding patient-to-patient transmission. The recent introduction of routine whole-genome sequencing (WGS) as a replacement for existing reference techniques in England provides an opportunity to characterize the genetic determinants of resistance. We conducted a systematic review to catalogue all known resistance-determining mutations. This knowledge was used to construct a predictive algorithm based on mutations in the erm(41) and rrl genes which was tested on a collection of 203 sequentially acquired clinical isolates for which there were paired genotype/phenotype data. A search for novel resistance-determining mutations was conducted using a heuristic algorithm. The sensitivity of existing knowledge for predicting resistance in clarithromycin was 95% (95% confidence interval [CI], 89 to 98%), and the specificity was 66% (95% CI, 54 to 76%). The subspecies alone was a poor predictor of resistance to clarithromycin. Eight potential new resistance-conferring single nucleotide polymorphisms (SNPs) were identified. WGS demonstrated probable resistance-determining SNPs in regions that the NTM-DR line probe cannot detect. These mutations are potentially clinically important, as they all occurred in samples that were predicted to be inducibly resistant and for which a macrolide would therefore currently be indicated. We were unable to explain all resistance, raising the possibility of the involvement of other as yet unidentified genes.

Authors: Lipworth, S; Hough, N; Leach, L; Morgan, M; Jeffery, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Society for Microbiology
• Journal: Antimicrobial Agents and Chemotherapy
• Volume: 63
• Issue: 1
• Article number: e01204-18
• Publication date: 2018-11-05
• Acceptance date: 2018-10-25
• DOI: 10.1128/aac.01204-18
• EISSN: 1098-6596
• ISSN: 0066-4804
• Pmid: 30397069
• Language: English
• Keywords: FFR; macrolides; whole-genome sequencing; nontuberculous mycobacteria